| NPI | 1669497434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 23621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 4894128-1205) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2026-04-23 |