| NPI | 1235753294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101027512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-165291) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-03-17 |