| NPI | 1922667252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301506382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL82775) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-09-08 |