| NPI | 1710141593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2020-0125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 84592) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2023-10-24 |