| NPI | 1578137162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 36294) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8950) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-07-22 |