| NPI | 1386025286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0099159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018022306) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-05-31 |