| NPI | 1306468640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 60737) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079627) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2025-06-25 |