| NPI | 1376923250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0074853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD463687) |
| 207R00000X Internal Medicine (Licence: IA R-10311) | |
| 207R00000X Internal Medicine (Licence: NY 305535) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2026-03-10 |