| NPI | 1154816858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021028418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018022261) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-03-07 |