| NPI | 1891813416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G065257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G652570) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-03-01 |