| NPI | 1205456597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-02005) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 0000000000000) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-10-16 |