| NPI | 1720082530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-11147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 11939R) |
| 207R00000X Internal Medicine (Licence: LA MD.11939R) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-04-17 |