| NPI | 1215433198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 157427) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 10456) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2022-07-25 |