| NPI | 1235659822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 89132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD471261) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-06-27 |