| NPI | 1679130850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME155668) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067103) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-01-26 |