| NPI | 1720090558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54927) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD-062912-L) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-06-29 |