| NPI | 1609131499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 49933) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73599) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2021-06-04 |