| NPI | 1598404832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301514511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351050289) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2025-08-12 |