| NPI | 1114449022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL ME156003) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22156) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-05-03 |