| NPI | 1467403246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A112504) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12929) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-01-05 |