| NPI | 1689164949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A19086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101025043) |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2024-02-27 |