| NPI | 1801029483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A116432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 52663) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2025-05-02 |