| NPI | 1811731573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 3016957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 3016957) |
| 207R00000X Internal Medicine (Licence: NM 3016957) | |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2026-01-29 |