| NPI | 1093249617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI In Progress) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD226496) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2026-05-22 |