| NPI | 1760923015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 92290) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD197750) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2025-01-06 |