| NPI | 1790148260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 79517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD26326) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-06-29 |