| NPI | 1891379855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 73978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R78580) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2025-01-15 |