| NPI | 1639177066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 44056) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 44056) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: GA 44056) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2025-03-24 |