| NPI | 1558682765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 4210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 36554) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2025-05-29 |