| NPI | 1649839051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-11626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD479384) |
| 207R00000X Internal Medicine (Licence: VA 0101276622) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-10-18 |