| NPI | 1083238562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 96037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11878) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2023-07-24 |