| NPI | 1750679379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 18806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME120944) |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2024-06-10 |