| NPI | 1558059592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 1558059592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 100550-851) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2025-05-08 |