| NPI | 1710951694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 76862) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 22999) |
| 207R00000X Internal Medicine (Licence: NY 162479) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2025-09-11 |