| NPI | 1194302976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRO-2016) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2024-06-13 |