| NPI | 1497320956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-01292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116035185) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2025-01-10 |