| NPI | 1669150249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 3014627) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 83441) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2026-09-24 |