| NPI | 1679033732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0018381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D92954) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2025-04-09 |