| NPI | 1790753093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM A-1383-06) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A8592) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-04-09 |