| NPI | 1154715001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A148689) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2021-02-18 |