| NPI | 1477016319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022013349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 6939) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-12-02 |