| NPI | 1790365302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0103618) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD500002758) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-07-15 |