| NPI | 1154980829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A178169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID 8261674) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2024-11-08 |