| NPI | 1063552420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM DO2025-0043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 011346) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2026-01-06 |