| NPI | 1982086898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A17572) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI DOR-339) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2022-09-25 |