| NPI | 1053818898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101272322) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-06-03 |