| NPI | 1255855672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PA MT233783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN25714) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2025-07-03 |