| NPI | 1184915043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-01080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 92171) |
| 207R00000X Internal Medicine (Licence: NC 173271) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2026-05-06 |