| NPI | 1922531458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 57052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.165650) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2026-04-19 |