| NPI | 1518692086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102209427) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R3748) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2025-12-23 |