| NPI | 1326741612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 19666A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS23219) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2026-06-14 |