| NPI | 1669965133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 88373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009952) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-05-05 |