| NPI | 1275264319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 36982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 9350) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2025-07-22 |