| NPI | 1053803940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A200368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101268175) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-06-09 |