| NPI | 1972092187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD48374) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76728) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2021-10-29 |