| NPI | 1821094772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC 21494) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0050328) |
| 207R00000X Internal Medicine (Licence: SC 34202) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2024-07-23 |