| NPI | 1619952041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 28006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 39962) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2024-05-15 |