| NPI | 1972948420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101026397) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID O-0949) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-02-09 |