| NPI | 1043830615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014271) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220320) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2023-05-10 |