| NPI | 1811917917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-14766) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 11822) |
| 207R00000X Internal Medicine (Licence: SC 26564) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-07-19 |