| NPI | 1235458092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD440738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA IMLC.MD.61522619) |
| 207R00000X Internal Medicine (Licence: CA C144889) | |
| 207R00000X Internal Medicine (Licence: NC 2022-02418) | |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2025-08-19 |