| NPI | 1912490863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301512852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01086693A) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-01-06 |