| NPI | 1356183651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-13203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-55555) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2026-02-21 |