| NPI | 1528596152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 86680) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2026001518) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2026-04-13 |