| NPI | 1861476137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-18274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME92650) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2025-08-22 |