| NPI | 1104943356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 12765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 111505) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2016-02-22 |