| NPI | 1003511734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 97704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL90196) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-08-28 |