| NPI | 1780101436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 87771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL U05318) |
| 207R00000X Internal Medicine (Licence: PA OS020974) | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-09-06 |