| NPI | 1134485006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A171527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME122212) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-04-05 |