| NPI | 1023750304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1023828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 82327) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2026-06-18 |