| NPI | 1538655709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01087004A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 15248) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-05-01 |