| NPI | 1629691845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 33179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-54712) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-09-03 |