| NPI | 1417304569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 49317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 59094) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2026-06-14 |