| NPI | 1962816512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD44150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7201) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-12-26 |