| NPI | 1962819458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101282376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0086227) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2025-01-20 |