| NPI | 1932776176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023010361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021019849) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-05-17 |