| NPI | 1053587659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 163207) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 038293) |
| Enumeration Date | 2008-05-03 |
| Last Update Date | 2023-01-19 |