| NPI | 1033461934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 020042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259841) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2026-03-18 |