| NPI | 1972966620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 401760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 68684) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2021-04-05 |