| NPI | 1275685166 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-00216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 41927) |
| 207R00000X Internal Medicine (Licence: VA 0101246488) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-02-05 |