| NPI | 1770005357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 198104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021021838) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2024-12-10 |