| NPI | 1972940112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-01961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D81093) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2024-04-18 |