| NPI | 1871518068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 17619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 35489) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-10-29 |