| NPI | 1689944639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120169) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A120169) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2022-02-11 |