| NPI | 1407926405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A98892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36116123) |
| 207R00000X Internal Medicine (Licence: AZ 36382) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-03-29 |