| NPI | 1346244373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A76725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0058597) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2018-07-31 |