| NPI | 1902225782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-19136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 65430-20) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-06-09 |