| NPI | 1770016040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A202936) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.162803) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-09-30 |