| NPI | 1952334047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME96030) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2017-10-06 |