| NPI | 1720643083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A19614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV DO3019) |
| 208D00000X General Practice (Licence: NV DO3019) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2022-06-10 |