| NPI | 1326783796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 97051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2025-0433) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2026-06-02 |