| NPI | 1801848650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 93068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2006-01587) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-04-15 |