| NPI | 1831194992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301100071) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004799) |
| 208M00000X Hospitalist (Licence: MI 4301100071) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-08-13 |