| NPI | 1992322101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MDCE.ML.70118222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P105592) |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2026-07-14 |