| NPI | 1750386959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-03273) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101231095) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2025-03-13 |