| NPI | 1457375040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R9445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G88832) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-12-13 |