| NPI | 1942707880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 009092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R2958) |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2022-06-01 |