| NPI | 1366939621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD227950) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 63339) |
| 207R00000X Internal Medicine (Licence: SC 94158) | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2026-04-11 |