| NPI | 1689954406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C169227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD452189) |
| 207R00000X Internal Medicine (Licence: PA MT199667) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2026-05-27 |