| NPI | 1902338742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-02081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 4226-320) |
| 207R00000X Internal Medicine (Licence: ID 9771440) | |
| 207R00000X Internal Medicine (Licence: MN 76533) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2025-05-20 |