| NPI | 1790417855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2026002228) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022024043) |
| 207R00000X Internal Medicine (Licence: MO 2024023940) | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2026-06-20 |