| NPI | 1811345655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD204208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267446) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2025-06-10 |