| NPI | 1750540316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A110720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 6353641-1205) |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2022-01-20 |