| NPI | 1285216648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101027859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-01487) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2026-08-24 |