| NPI | 1972990166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A158229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21203) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2022-02-04 |