| NPI | 1740808815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A186384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020020164) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2023-06-30 |