| NPI | 1235398629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C170589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME106872) |
| 207R00000X Internal Medicine (Licence: MA 238660) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2026-01-09 |