| NPI | 1902302425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-16035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-1706) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-06-20 |