| NPI | 1235659467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MI 5101025845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023278) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-05-16 |