| NPI | 1881043602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-01875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-10598) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2021-12-01 |