| NPI | 1699773127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C137799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101237920) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-10-02 |