| NPI | 1649822354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351044776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 44440) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2025-11-04 |