| NPI | 1821658246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC ll82621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD496107) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-07-16 |