| NPI | 1508246935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-01456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 37669) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-01-24 |