| NPI | 1538722483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 91539) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 10800) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-02-02 |