| NPI | 1689369100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2026-03609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC POWE-VZK6X7) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-07-22 |