| NPI | 1760042568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 80078) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019015882) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-06-26 |