| NPI | 1366192940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301514113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079417) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-08-13 |