| NPI | 1508246398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 56091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015014465) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-06-27 |