| NPI | 1548767130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E14542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022008783) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2025-03-19 |