| NPI | 1831528363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2958) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2015-12-18 |