| NPI | 1285269704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00218) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101273707) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2024-07-14 |