| NPI | 1881323533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 3055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12579) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-07-01 |