| NPI | 1760653125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS10941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A23807) |
| 207R00000X Internal Medicine (Licence: TX W0055) | |
| 207R00000X Internal Medicine (Licence: NY 247867) | |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2026-08-12 |