| NPI | 1134202849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C131631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 22709) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-03-21 |