| NPI | 1710143326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G178866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 15309) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2023-03-06 |