| NPI | 1982015681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.38251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 324869) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2025-10-13 |