| NPI | 1598931131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A112203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD p22573) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2021-03-29 |