| NPI | 1598252629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 45115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-02975) |
| Enumeration Date | 2018-04-14 |
| Last Update Date | 2022-12-12 |