| NPI | 1770223562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID 7171372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-2124) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-03-13 |