| NPI | 1790048338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D83457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD475063) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-09-18 |