| NPI | 1710675483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R80259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA F4507488) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2026-06-18 |