| NPI | 1518961028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 21368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA L022746) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2023-03-07 |