| NPI | 1558768945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-03531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15765) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2025-06-18 |