| NPI | 1407119019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A156147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.34565) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-03-25 |