| NPI | 1598403354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-12494) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-53770) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-03-11 |