| NPI | 1689290298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 24010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 87378-20) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2026-05-19 |