| NPI | 1104208743 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: GA 78438) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 78438) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2023-05-06 |