| NPI | 1770076168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315254798) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2025-07-30 |