| NPI | 1891114666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 13567339-1204) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-10-25 |