| NPI | 1356081525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-02491) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL87661) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-08-13 |