| NPI | 1619327210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-02359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 39483) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2025-05-22 |