| NPI | 1942512199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 46694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-15511) |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2022-06-23 |