| NPI | 1861280059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R81633) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 112248) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-06-10 |