| NPI | 1821438995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022039016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 075886) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2022-10-03 |