| NPI | 1124682323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 89689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 28889) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2024-02-02 |