| NPI | 1669729729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 24973) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 25363) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2026-06-24 |