| NPI | 1124522461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD27960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-01703) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-11-18 |