| NPI | 1902368970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-16579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-1805) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-07-21 |