| NPI | 1811296684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 55017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS12190) |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2022-09-29 |