| NPI | 1912956947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 88903) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9601083) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2025-08-19 |