| NPI | 1346746948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A19376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS021069) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-07-12 |