| NPI | 1992159305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 58612) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-02-23 |