| NPI | 1821659780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021018762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019021915) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2022-06-15 |