| NPI | 1003814823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 5270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A64167) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2021-03-17 |