| NPI | 1922501204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MDO.83463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101025371) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2021-06-28 |