| NPI | 1043897481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID 7971137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02007224A) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-07-01 |