| NPI | 1871081745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-00691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 97260) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2026-07-27 |