| NPI | 1871881508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 94332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 308600) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2024-12-05 |