| NPI | 1225619323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-01039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T-4378) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-05-07 |