| NPI | 1164154175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN36304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN34697) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-07-12 |