| NPI | 1053682195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 260711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A119420) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2016-02-29 |