| NPI | 1811629793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-02982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 14292) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2025-11-04 |