| NPI | 1740863273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A22404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R3570) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-07-08 |