| NPI | 1477596104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101259349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20934) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2026-07-09 |