| NPI | 1871731331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 13486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G54803) |
| 207R00000X Internal Medicine (Licence: IL 036.129425) | |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2025-08-24 |