| NPI | 1023268869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C165968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 8125) |
| 207R00000X Internal Medicine (Licence: NE TEP 5824) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2019-12-18 |