| NPI | 1912958810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301076062) |
| Additional Taxonomies | 132700000X Dietary Manager (Licence: MI 4301076062) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-02-24 |