| NPI | 1013919083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 17069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 109666) |
| 207R00000X Internal Medicine (Licence: CA G87070) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2025-11-23 |