| NPI | 1215999107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0099241) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C03163) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2024-03-26 |