| NPI | 1568203800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 1111111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 1568203800) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-07-02 |