| NPI | 1609579770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101288688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.49830) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-07-12 |