| NPI | 1962939165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01084461A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301112007) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2025-01-09 |