| NPI | 1295142545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-01525) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC MMD.84812) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2022-06-14 |