| NPI | 1851738611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-52522) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2016-0034) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-02-22 |