| NPI | 1386179281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A167191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD20832) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2021-11-01 |