| NPI | 1477554905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C55996) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI 9916) |
| 207R00000X Internal Medicine (Licence: MA 154266) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-08-10 |