| NPI | 1760844765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-47030) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0087489) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-10-07 |