| NPI | 1891430393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A201730) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R79508) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2025-05-28 |