| NPI | 1770550220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 18473) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 18473) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2021-03-08 |