| NPI | 1477073518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 85666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8036) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-08-11 |