| NPI | 1114480209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2025-1294) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E15275) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2026-02-12 |