| NPI | 1417044132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A97308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 36003) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-11-15 |