| NPI | 1801457650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01087116A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045670) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2022-06-02 |