| NPI | 1902547615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101028020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151015622) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-02-25 |