| NPI | 1235793878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 92307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 32986) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-06-24 |