| NPI | 1104403591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 21252) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-09-10 |