| NPI | 1184204588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 91366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 05904) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-08-08 |