| NPI | 1689101768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-15987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2020-02256) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2026-01-06 |