| NPI | 1598296956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-00616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 90539) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-07-21 |