| NPI | 1366001323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 18789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8511) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2022-09-29 |