| NPI | 1215624762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 8514520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 100048-851) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-01-07 |