| NPI | 1164116612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD53466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12741) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-10-21 |