| NPI | 1982842019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-11395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 237566) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2025-10-27 |