| NPI | 1679937643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A158942) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 61669) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-08-19 |