| NPI | 1043457005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A137266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD29410) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2022-12-14 |