| NPI | 1992453534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R4113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV DO4127) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2026-09-22 |