| NPI | 1215083563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 29495) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 29495) |
| 207Q00000X Family Medicine (Licence: NC 29495) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2026-02-05 |