| NPI | 1679748537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME101463) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2024-06-18 |