| NPI | 1639525538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 75866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75866) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2022-10-04 |