| NPI | 1275023780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173641) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275695) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-07-20 |