| NPI | 1649762212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101023857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-01717) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2021-05-24 |