| NPI | 1295168854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301509867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM RS2013-0392) |
| Enumeration Date | 2013-08-17 |
| Last Update Date | 2023-08-28 |