| NPI | 1750837712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 010128068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268038) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2026-06-15 |