| NPI | 1407866288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G145782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME72900) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-07-16 |