| NPI | 1699842914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G74715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 25985) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-12-07 |