| NPI | 1477272672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125080470) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-06-10 |