| NPI | 1891359071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 66811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2025-0604) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2025-07-14 |