| NPI | 1508481003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11954) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-07-06 |