| NPI | 1831128560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-00810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0068123) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-09-14 |