| NPI | 1134613854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2024-0184) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276591) |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2024-11-05 |