| NPI | 1629270723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 90904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 203107) |
| 207R00000X Internal Medicine (Licence: FL ME104781) | |
| 207R00000X Internal Medicine (Licence: PA MD462573) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-01-27 |