| NPI | 1861019614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 3013596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220567) |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2023-12-26 |