| NPI | 1649665795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A153863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD38775) |
| 207R00000X Internal Medicine (Licence: MN 69027) | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2024-04-19 |