| NPI | 1346675246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 072536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A124358) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2016-08-05 |