| NPI | 1659986719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01089782A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.077055) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2023-08-30 |