| NPI | 1306466255 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301513751) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075660) | 
| Enumeration Date | 2020-04-21 | 
| Last Update Date | 2025-08-01 |