| NPI | 1518319995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS16081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 3335) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2025-07-26 |