| NPI | 1669886545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A169852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101262895) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-12-23 |