| NPI | 1760744577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MA 1015371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-251579) |
| 2085R0001X (Licence: MD D0082741) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2026-01-18 |