| NPI | 1568475614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C167516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 043290) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2025-11-24 |