| NPI | 1104302082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-12153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8272) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2021-06-11 |