| NPI | 1720720055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351049710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301514263) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-04-17 |