| NPI | 1902992894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 13870R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 17113) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-08-19 |