| NPI | 1497251060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A25458) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT A25458) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-04-03 |