| NPI | 1770976557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN1660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AS 2225C) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2025-07-24 |