| NPI | 1215671714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MMD.95187MD) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-01796) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2025-07-14 |