| NPI | 1225034150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01069679A) |
| 207R00000X Internal Medicine (Licence: TX M0212) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2026-08-10 |