| NPI | 1992376057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 71647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R78879) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-08-10 |