| NPI | 1922489285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL38279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 38279) |
| 207R00000X Internal Medicine (Licence: SC MD38279) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2024-02-26 |