| NPI | 1821445370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A163017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75581) |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2021-11-29 |