| NPI | 1881045359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 66147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A159528) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-01-17 |