| NPI | 1467733022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 92666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2013030594) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2025-02-06 |