| NPI | 1558680959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-18272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-00764) |
| 207R00000X Internal Medicine (Licence: NH 16262) | |
| 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-87668) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2024-03-19 |