| NPI | 1659755361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 61237) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 97887) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2023-11-13 |