| NPI | 1174861876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C173320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268957) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2021-08-24 |