| NPI | 1669755153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL UO2771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A15779) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2023-10-05 |