| NPI | 1922596501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173472) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A173472) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2025-08-24 |