| NPI | 1073036869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 23404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301504637) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-12-28 |