| NPI | 1861684524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2023-1468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD28556) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2025-01-02 |