| NPI | 1023571122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 89576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 66092) |
| 207R00000X Internal Medicine (Licence: AZ R77234) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2023-06-25 |