| NPI | 1588349880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025038600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.082074) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2025-09-15 |