| NPI | 1871553016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.07053R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2006-00034) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-12-30 |