| NPI | 1497329676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 104417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 78934) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2025-08-06 |