| NPI | 1114651346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.079987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61647021) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2025-07-10 |