| NPI | 1245592922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 50352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73371) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2025-01-04 |