| NPI | 1437844693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A205278) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A205278) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-04-13 |