| NPI | 1619950557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-00963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 48633) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2024-01-26 |