| NPI | 1376075101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 92906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.49080) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-07-12 |