| NPI | 1982664678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9700075) |
| Additional Taxonomies | 208VP0000X (Licence: NC 9700075) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2026-03-04 |