| NPI | 1902018385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a103675) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: CA A103675) |
| 282N00000X General Acute Care Hospital (Licence: CA A103675) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2022-05-15 |