| NPI | 1326051939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9600917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 102037015) |
| 207R00000X Internal Medicine (Licence: TN 1205) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2026-06-09 |