| NPI | 1114433687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A18084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO5662) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2020-10-09 |