| NPI | 1326788142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A191860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 27657) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-12-10 |