| NPI | 1083009930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 111039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP789) |
| 207R00000X Internal Medicine (Licence: AL 4273) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2026-09-01 |