| NPI | 1457415143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C22470) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C224701) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2017-02-09 |