| NPI | 1881030674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A135115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73818) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2016-12-22 |