| NPI | 1780315374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 76424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351049344) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2025-07-28 |