| NPI | 1669959979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 328670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301116185) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2023-08-18 |