| NPI | 1770539389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 23185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2006-00889) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-10-05 |