| NPI | 1730884727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A25309) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R4156) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2026-06-06 |