| NPI | 1285897421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A128469) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D71586) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2018-09-27 |