| NPI | 1588005474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301103780) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A142675) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2023-12-29 |