| NPI | 1962039958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 156192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-16711) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-06-26 |