| NPI | 1730701988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 60738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079628) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2025-10-06 |