| NPI | 1063939007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP04142) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61294274) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2025-06-18 |