| NPI | 1720655285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 99236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12866) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2024-06-20 |