| NPI | 1508483504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1014369) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-12-15 |