| NPI | 1902014509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301087325) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 14707-320) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2026-04-06 |