| NPI | 1174351100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A200867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301512448) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2025-02-21 |