| NPI | 1073173241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022026494) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN29501) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-07-14 |