| NPI | 1669419941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 0S9361) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-04-17 |