| NPI | 1639691777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-02724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270186) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2024-12-24 |