| NPI | 1760487904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 28812) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 24152) |
| 207R00000X Internal Medicine (Licence: SC TL28812) | |
| 207R00000X Internal Medicine (Licence: TN 39383) | |
| 207R00000X Internal Medicine (Licence: FL ME92754) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-02-09 |