| NPI | 1831754969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2025-1049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-113356) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2026-07-22 |