| NPI | 1902865421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01063801A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 36350) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2023-05-05 |