| NPI | 1982158143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL ME178176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P33504) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2026-08-28 |