| NPI | 1134500309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 158144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264218) |
| 207R00000X Internal Medicine (Licence: MA 274181) | |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2024-02-23 |