| NPI | 1962584920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c52426) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MI 4301066754) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2016-12-22 |