| NPI | 1134675564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-01970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 008279) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2024-07-16 |