| NPI | 1053752832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD214386) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 269613) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2023-07-11 |