| NPI | 1952857591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD211807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7748) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-08-22 |