| NPI | 1740487271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 77536) |
| 207R00000X Internal Medicine (Licence: AZ 77370) | |
| 207R00000X Internal Medicine (Licence: NH 39256) | |
| 207R00000X Internal Medicine (Licence: GA 104799) | |
| 207R00000X Internal Medicine (Licence: TX V8467) | |
| 207R00000X Internal Medicine (Licence: NC 2026-00126) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2026-10-06 |