| NPI | 1720472632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-15668) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10108623-1205) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2025-02-12 |