| NPI | 1083097976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 66104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME EL181059) |
| 207R00000X Internal Medicine (Licence: CO 0064570) | |
| 207R00000X Internal Medicine (Licence: NY 295385) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2026-05-18 |