| NPI | 1689257214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: AZ 80211) |
| Additional Taxonomies | 2085R0001X (Licence: AZ R78643) |
| 207R00000X Internal Medicine (Licence: AZ R78643) | |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2026-06-04 |