| NPI | 1154777456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 82225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 218275) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2024-03-05 |