| NPI | 1902099518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 159380-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61072641) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2026-03-17 |