| NPI | 1730704701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NE 9310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 1730704701) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2026-05-01 |