| NPI | 1487689477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301056955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 203248) |
| 207R00000X Internal Medicine (Licence: DE C1-0008072) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-04-23 |