| NPI | 1922044791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 97.01503) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2025-10-17 |