| NPI | 1588161400 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-14601) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023050589) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2024-05-31 |