| NPI | 1619084761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01060057A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 107681) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2026-05-04 |