| NPI | 1730742818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO216984) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS19179) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-12-13 |