| NPI | 1710500343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 35626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-51276) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-10-27 |