| NPI | 1124680269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 66263) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD22953) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2022-08-03 |