| NPI | 1124757315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL88052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 88052) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-05-16 |