| NPI | 1053757781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A154219) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204467) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2025-08-20 |