| NPI | 1962023754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME169907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 22993) |
| 207R00000X Internal Medicine (Licence: OH 35.154509) | |
| 207R00000X Internal Medicine (Licence: MI 4301507158) | |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2026-01-15 |