| NPI | 1700379351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R76670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD-21800-0) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2021-04-30 |