| NPI | 1477971745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL os19159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC DO034567) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-09-08 |