| NPI | 1841826179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A184236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 60638) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-05-01 |