| NPI | 1700925211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A108658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-112248) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-02-13 |