| NPI | 1932778990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 101610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 9124) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-08-30 |