| NPI | 1821193699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 25754) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268822) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2026-08-05 |