| NPI | 1083119762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 85771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 238475) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2021-10-08 |