| NPI | 1316300601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020019938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 56587) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2023-05-04 |