| NPI | 1740955061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 75758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289132) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2025-07-14 |