| NPI | 1598991184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM DO2023-1086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS12449) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2024-01-25 |