| 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: MI 5101028814) |
| 207R00000X Internal Medicine (Licence: FL OS22733) | |
| 207R00000X Internal Medicine (Licence: VA 0116035185) | |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2026-07-15 |