| NPI | 1669906632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A16883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV DO2734) |
| 207R00000X Internal Medicine (Licence: OH 34.016531) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-11-04 |