| NPI | 1558932814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0100496) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2026-04-03 |