| NPI | 1639602139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 24089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A156998) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-05-12 |