| NPI | 1740527944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A46188) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CA a46188) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2024-02-22 |