| NPI | 1366536237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 02942) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102202121) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2026-07-31 |