| NPI | 1174147987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11959) |
| 207R00000X Internal Medicine (Licence: MN 73349) | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-10-31 |