| NPI | 1225590839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL UO6526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 3912) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-05-04 |