| NPI | 1821198003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301049752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2026019548) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2026-08-13 |