| NPI | 1629001490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD-023108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-3962) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-06-19 |