| NPI | 1619506920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101279364) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 32929) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-12-29 |