| NPI | 1861050866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 93567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-03239) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-04-18 |