| NPI | 1558850859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 63786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76689) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2021-06-30 |