| NPI | 1679724033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD 23564) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 98076) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2025-03-27 |