| NPI | 1821004516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 35882) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-11-15 |