| NPI | 1720066350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME77816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 104045) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2023-05-30 |