| NPI | 1285127993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS21714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116031483) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2025-11-06 |