| NPI | 1699383091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023028058) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT221723) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2024-08-23 |