| NPI | 1548256977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-46368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 91977) |
| 174400000X Specialist (Licence: AZ 24459) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2026-01-28 |