| NPI | 1295152122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD23456) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207R00000X Internal Medicine (Licence: MN 63958) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-07-21 |