| NPI | 1700014529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A12210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018484) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2015-12-16 |