| NPI | 1730596040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-1193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C193091) |
| 207R00000X Internal Medicine (Licence: AZ 53863) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2026-08-12 |