| NPI | 1134440431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A136301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101256071) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2022-05-11 |