| NPI | 1114480068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A182181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD d0097287) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2023-09-25 |