| NPI | 1063584951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0072166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD 30157) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2026-01-01 |