| NPI | 1457714321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A181749) |
| 207R00000X Internal Medicine (Licence: NY 303505) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-06-30 |