| NPI | 1255835393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 79055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 12821441-1205) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-08-29 |