| NPI | 1861465288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-02367) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 41522) |
| 207R00000X Internal Medicine (Licence: SC 92373) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2026-06-04 |