| NPI | 1902253651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 30845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 219690) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-10-24 |