| NPI | 1548217680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: CA A31408) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A31408) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2019-12-31 |