| 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 |