| NPI | 1316331549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 55909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 17606C) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2025-05-28 |