| NPI | 1356927099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101284906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME167196) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-04-15 |