| NPI | 1972274231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2024036647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 290615) |
| Enumeration Date | 2021-09-25 |
| Last Update Date | 2024-10-16 |