| NPI | 1780065250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 62958) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301113701) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-04-26 |