| NPI | 1447811567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351045704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME157507) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-06-06 |