| NPI | 1699716340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-0306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 80976) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-04-29 |