| NPI | 1508286931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 12626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259175) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2023-12-18 |