| NPI | 1225004864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101235348) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2007-01470) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2025-06-17 |