| NPI | 1306427794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A208252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1019251) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2026-04-02 |