| NPI | 1992333512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.075952) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301510573) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-07-22 |