| NPI | 1821672718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 142207) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR Pg205412) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-11-05 |