| NPI | 1700876018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D84710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301097415) |
| 207R00000X Internal Medicine (Licence: FL ME84214) | |
| 207R00000X Internal Medicine (Licence: CA A62106) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-07-28 |