| NPI | 1891126140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME130028) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 11212) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2026-04-13 |