| NPI | 1285252973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021040341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020018526) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2021-12-08 |