| NPI | 1235549296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C193372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263444) |
| 207R00000X Internal Medicine (Licence: MA 277010) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-02-15 |