| NPI | 1053938845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351046356) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A191237) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-12-03 |