| NPI | 1154170710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 327899-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A22411) |
| 207R00000X Internal Medicine (Licence: WA OP61484104) | |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |