| NPI | 1871087437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 82783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A173711) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2026-01-21 |