| NPI | 1154997104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID o-1926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12085) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-05-23 |