| NPI | 1851359400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 13417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-100238) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2022-03-07 |