| NPI | 1972814176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 106776) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2024-04-11 |