| NPI | 1225768575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301514101) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351049441) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-06-27 |