| NPI | 1710334610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2019022432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 294156) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2024-10-15 |