| NPI | 1174031660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: SC PA2880) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 9335) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2024-07-31 |