| NPI | 1144979642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 93773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN35045) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-07-09 |