| NPI | 1568952778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 111137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101271726) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2026-06-11 |