| NPI | 1962495275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101233542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0060137) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2026-05-21 |