| NPI | 1538664479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A174097) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 11420209-1205) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-12-27 |