| NPI | 1255754719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101268267) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-02030) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2025-08-27 |