| NPI | 1982192019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-100931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 11405369-1205) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2021-09-21 |