| NPI | 1801387279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301504575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115096) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2021-06-17 |