| NPI | 1568456036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 27792) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 26212) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-04-07 |