| NPI | 1659523934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A126138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 48368) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2015-06-29 |