| NPI | 1649375494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G30841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G308-41) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-10-13 |