| NPI | 1437567260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-02649) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15807) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2025-08-01 |