| NPI | 1861462665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 84368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME41971) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-07-31 |