| NPI | 1649899394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: PA OT020210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 7969) |
| 207R00000X Internal Medicine (Licence: FL UO7969) | |
| 208600000X Surgery (Licence: PA OT020210) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-07-30 |