| NPI | 1790365815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-18953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2024030701) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-07-17 |