| NPI | 1548369671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.09376R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 09376R) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-03-06 |