| NPI | 1114300928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-05041) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2025-11-12 |