| NPI | 1699931097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 111390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A111390) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2020-03-12 |