| NPI | 1750389995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 37557) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301059151) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-11-17 |