| NPI | 1568968014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a173781) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 101932) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-09-18 |