| NPI | 1902195746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A123872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0071928) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2024-09-30 |