| NPI | 1154435006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101247739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 25245) |
| 207R00000X Internal Medicine (Licence: NC 2006-01239) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2026-08-19 |