| NPI | 1679214431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A209377) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD210012341) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-05-29 |