| NPI | 1013658392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 62055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 83546-20) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2026-07-14 |