| NPI | 1750876629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK 176399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018018693) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-10-03 |