| NPI | 1881057453 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: WI 82013-20)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 1204379)  | 
| Enumeration Date | 2016-03-31 | 
| Last Update Date | 2025-08-01 |