| NPI | 1043665128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54865) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ r75863) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2022-02-24 |