| NPI | 1982922498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 86071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019013765) |
| 207R00000X Internal Medicine (Licence: NC 201401212) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2024-01-25 |