| NPI | 1922374040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD173679) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A130126) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2026-06-15 |