| NPI | 1114217486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-21440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A113533) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2021-06-09 |