| NPI | 1619464310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1560) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRO-1708) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2021-11-15 |