| NPI | 1821416223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-02437) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 24986) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2021-12-08 |