| NPI | 1124764667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5315259171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 23799) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-01-15 |