| NPI | 1003377862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301506349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351044689) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-03-13 |