| NPI | 1790303501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 74944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 000000) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2023-07-06 |