| NPI | 1861016354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 346156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 32303) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-07-07 |