| NPI | 1003334574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA SP-0272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213660) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2023-11-15 |