| NPI | 1376292938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD20840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A202393) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-08-12 |