| NPI | 1982022448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 59773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD178262) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-04-30 |