| NPI | 1164029146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023047698) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2020030624) |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2025-10-16 |