| NPI | 1609368786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301505092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115490) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2024-01-02 |