| NPI | 1689038291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL md38593) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2022-11-03 |