| NPI | 1649767294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A202629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023011921) |
| 207R00000X Internal Medicine (Licence: LA 326587) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2026-01-09 |