| NPI | 1902483886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 39264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 12994444-1205) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2026-04-07 |