| NPI | 1376930586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME DO3524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI DO00872) |
| 207R00000X Internal Medicine (Licence: CT 56637) | |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2025-02-24 |