| NPI | 1871576041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G88613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD19791) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2020-11-19 |