| NPI | 1053894774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 46431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 22565) |
| Enumeration Date | 2018-09-09 |
| Last Update Date | 2023-08-30 |