| NPI | 1174936330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A149567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105533) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-07-21 |