| NPI | 1740741164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 332688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 73913) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-06-27 |