| NPI | 1760989784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MMD.86690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 99163) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-06-09 |