| NPI | 1043716533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301510073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD473258) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-08-22 |