| NPI | 1669481594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G49369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G49369) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2023-09-08 |