| NPI | 1306011077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 61991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 128423) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2025-04-16 |