| NPI | 1457973133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101029225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151014377) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2026-05-19 |