| NPI | 1316359847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-02117) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 202429) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2025-07-24 |