| NPI | 1386887974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A125206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 56266-20) |
| Enumeration Date | 2009-04-12 |
| Last Update Date | 2026-02-18 |