| NPI | 1639608946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025010418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301501839) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2025-07-03 |