| NPI | 1902555923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 35716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 105358) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2025-09-09 |