| NPI | 1427612365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2023-1310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 22669) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2023-09-22 |