| NPI | 1508817214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-17388) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9700162) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-10-11 |