| NPI | 1386870376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 71554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2012-0165) |
| 207R00000X Internal Medicine (Licence: OR LL18732) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2025-04-17 |