| NPI | 1033614102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 92421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D91517) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-08-31 |