| NPI | 1083293559 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61611044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 169401) |
| 207R00000X Internal Medicine (Licence: NY 33282501) | |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2024-10-28 |