| NPI | 1619598505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R78072) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2023-06-30 |