| NPI | 1326539131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 89541) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL52465) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2022-02-21 |