| NPI | 1205451945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 74960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 8656-851) |
| 207R00000X Internal Medicine (Licence: WI 77219-20) | |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2023-06-22 |