| NPI | 1285318758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1027019) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT229306) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-05-07 |