| NPI | 1578994984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 65455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 273470) |
| 207R00000X Internal Medicine (Licence: IA 41576) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2024-05-17 |