| NPI | 1962030080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM DO2023-1012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 390200000X) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-04-02 |