| NPI | 1417057316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 11054) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 134958) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-10-21 |