| NPI | 1366019788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101282624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116035203) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-07-29 |