| NPI | 1932605425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 21645) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 149932) |
| 207R00000X Internal Medicine (Licence: FL ME149932) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-12-26 |