| NPI | 1518495225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025424) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2026-08-27 |