| NPI | 1831189752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 73144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 110355) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2023-01-25 |