| NPI | 1104185164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116023971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 60459590) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2026-01-27 |