| NPI | 1477841641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C162648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098300) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2022-09-01 |