| NPI | 1255723946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102204620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101026466) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2025-08-16 |