| NPI | 1043731193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 91563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 81571) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-04-16 |