| NPI | 1487359816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 89904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL89904) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-07-24 |