| NPI | 1891369609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025030370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0450844) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2026-03-30 |