| NPI | 1902841885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 23987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 34696) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2025-02-12 |