| NPI | 1861888042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-03040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115737) |
| 207R00000X Internal Medicine (Licence: OR MD191031) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2023-02-23 |