| NPI | 1013986264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 51128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101221395) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2026-01-16 |