| NPI | 1801141957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-42280) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301101195) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2025-09-05 |