| NPI | 1427212703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 44167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R71139) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-07-29 |