| NPI | 1588003479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO3654) |
| 207R00000X Internal Medicine (Licence: TN 3042) | |
| 207R00000X Internal Medicine (Licence: FL OS 12936) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2024-06-04 |