| NPI | 1063075695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a195817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG193628) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2024-10-29 |