| NPI | 1942506472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A151770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 282165) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2026-04-03 |