| NPI | 1598853939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 28549) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 32483) |
| 207R00000X Internal Medicine (Licence: NC 2010-00652) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-02-10 |