| NPI | 1356804645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301506474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 68936) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2023-08-31 |