| NPI | 1760299077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: AZ 10966) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10966) |
| Enumeration Date | 2024-12-11 |
| Last Update Date | 2025-02-24 |