| NPI | 1942984539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 5072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151016454APP23) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-10-01 |