| NPI | 1407475007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO216717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 199461) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2023-08-17 |