| NPI | 1538154505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 43241) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 025461) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2024-04-16 |