| NPI | 1184309122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 40056) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT022669) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2026-08-11 |