| NPI | 1952750556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1017771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101263082) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2024-09-06 |