| NPI | 1528024056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G62147) |
| 207R00000X Internal Medicine (Licence: OR MD26851) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2022-03-10 |