| NPI | 1487730776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ PB3541) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G85923) |
| 207R00000X Internal Medicine (Licence: AZ 20913) | |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2021-01-05 |