| NPI | 1447923602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 289750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101280948) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2024-07-29 |