| NPI | 1568673531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301086792) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C-142908) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-10-14 |