| NPI | 1053844423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: NC 2022-01489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 227610) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-09-04 |