| NPI | 1194288597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R77320) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2022-08-25 |