| NPI | 1851823231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 93810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 83811) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-01-10 |