| NPI | 1528267770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-01850) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 89344) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2026-02-24 |