| NPI | 1962437053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 68021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 154140) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-07-16 |