| NPI | 1811316359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 1600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H0095648) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2026-08-10 |