| NPI | 1235690850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS18701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL82150) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2022-08-01 |