| NPI | 1750638516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101021764) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012020880) |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2024-09-16 |