| NPI | 1811559750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 11622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD477640) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2026-07-01 |