| NPI | 1760121214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125079744) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-06-10 |