| NPI | 1558939389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023035473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021021827) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-09-19 |