| NPI | 1114411154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1018531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276212) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-10-31 |