| NPI | 1639499254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 100840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC MMD.32722 LL) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2025-06-24 |