| NPI | 1376172874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 175116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD20175) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-07-10 |