| NPI | 1689175143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS024372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 2085) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2025-07-28 |