| NPI | 1740869676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A194399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101280730) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-06-25 |