| NPI | 1962039149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 12439701-1205) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-07-08 |