| NPI | 1811328396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61261486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09454600) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2023-06-23 |