| NPI | 1588313431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO NA) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1024304) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2025-08-07 |