| NPI | 1902421233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101278375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 84469) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2026-09-29 |