| NPI | 1922423532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1441) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 25160) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2026-05-05 |