| NPI | 1629719422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 011599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12633) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-08-20 |