| NPI | 1205364759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD500003082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0100268) |
| 207R00000X Internal Medicine (Licence: CT 65326) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-05-06 |