| NPI | 1316044308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-02488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A71059) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-06-25 |