| NPI | 1427642602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-02660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO8733) |
| Enumeration Date | 2021-02-27 |
| Last Update Date | 2025-10-06 |