| NPI | 1609281187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-01748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105688) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-07-21 |