| NPI | 1306923883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A401350) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A40135) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-03-07 |