| NPI | 1639889165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-22986) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A-180347) |
| 207R00000X Internal Medicine (Licence: WA MD61232882) | |
| 207R00000X Internal Medicine (Licence: CA A180347) | |
| 207R00000X Internal Medicine (Licence: FL ME160299) | |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-09-06 |