| NPI | 1205499506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A177582) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R77313) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2022-07-06 |