| NPI | 1891171609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 52101) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD483152) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2026-02-03 |