| NPI | 1174882658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 3042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 03770) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2026-07-23 |