| NPI | 1447866579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-12678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125075734) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2025-08-15 |