| NPI | 1497276620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D98805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 68107) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-05-02 |