| NPI | 1790248334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-01894) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102206698) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-11-21 |