| NPI | 1528596194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 032.0134220) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018040) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2026-09-08 |