| NPI | 1265921522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00311) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072388) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2025-03-31 |