| NPI | 1508151036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL0826) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2018-09-11 |