| NPI | 1811514466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A187127) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020018849) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-01-28 |