| NPI | 1093277014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-16384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 11885646-1205) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-07-18 |