| NPI | 1982184156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 75441) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351027563) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2023-04-19 |