| NPI | 1750390506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-02013) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 19456) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-02-06 |