| NPI | 1205525540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 74670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R80141) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2024-10-21 |