| NPI | 1710447628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A186395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-7700) |
| 207R00000X Internal Medicine (Licence: HI MD-22539) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-07-01 |