| NPI | 1477009686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C192637) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7846) |
| 207R00000X Internal Medicine (Licence: NE 31718) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-05-28 |