| NPI | 1174621320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 6630A) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-09-18 |