| NPI | 1639116023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 34839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 25426) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-07-23 |