| NPI | 1215321971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 79930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 208316) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2024-08-15 |