| NPI | 1720582083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A164074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 286476) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-08-18 |