| NPI | 1609944180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2006-0751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G36968) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-12-07 |